Med-Surg Immune System, part 7: HIV and AIDS - Signs, Symptoms, Diagnosis and Treatment
In this article, we go in depth on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), which are important to know for your Med-Surg classes and nursing practice. This virus and condition are covered in our Medical-Surgical flashcards (Immune system), and Cathy’s video follows along with the cards.
Human immunodeficiency virus (HIV)
HIV is a virus that enters the body through the blood or bodily fluids and targets the CD4+ lymphocytes (helper T cells), resulting in immunodeficiency, autoimmunity, and neurologic dysfunction.
Risk factors that place an individual at high risk for HIV include unprotected sex, multiple sex partners, perinatal exposure (like during childbirth), IV drug use, and being a healthcare worker. The reason that being a healthcare worker puts you at higher risk for contracting HIV is because of the potential for an accidental needlestick. Let this be another reminder to do everything you can to prevent needlestick injuries and exposure to blood and bodily fluids whenever possible!
Signs and symptoms
Signs and symptoms of HIV include flu-like symptoms, lymphadenopathy (enlarged lymph nodes), thrush (yeast-like infection of the tongue), weakness, night sweats, fever, weight loss, and rashes on the skin.
HIV lab values
When patients have HIV, their white blood cell (WBC) and CD4+ counts will be decreased.
CD4+ T-lymphocytes are a type of lymphocyte that triggers the body’s immune response to infection. Decreased CD4+ count results in decreased immune function and increased susceptibility to infections.
- HIV Stage 1 is marked by greater than 500 cells/mm³.
- HIV Stage 2 is marked by 200 - 499 cells/mm³.
- HIV Stage 3 (AIDS) is marked by less than 200 cells/mm³.
Need to remember CD4+ levels for an exam? CD4+ is just one of many important lab values covered in our Lab Values flashcards for nursing students.
Diagnosis of HIV
To diagnose HIV, a patient should first undergo an enzyme-linked immunosorbent assay (ELISA) test to detect HIV antibodies and antigens in the blood, and if that is positive, HIV can be confirmed with a Western Blot test. A western blot test separates blood proteins and is able to isolate the proteins that make up the HIV antibodies so their existence can be confirmed.
Acquired immunodeficiency syndrome (AIDS)
AIDS stands for acquired immunodeficiency syndrome. If HIV goes untreated, the CD4+ count drops even lower, and if it falls below 200 cells/mm³, that is indicative of AIDS.
While HIV is a virus that can cause an infection, AIDS is a persistent condition caused by the effects of the virus.
Signs and symptoms of AIDS
The signs and symptoms of AIDS are much worse than the signs and symptoms of HIV. These include tuberculosis, pneumonia, wasting syndrome (unwanted excessive weight loss), candidiasis of the airways (a fungal infection of the respiratory system), and Kaposi’s sarcoma, which is a cancer of the skin and soft tissue.
These symptoms occur opportunistically because the immune system is not healthy enough to fight them off as it normally would.
When HIV/AIDS was first discovered, it was considered a fatal disease because there was no treatment available yet. Over the years, we have made many advancements in medicine that have made HIV manageable.
A patient with HIV/AIDS should undergo antiretroviral therapy (ART) to slow the progression of the virus. Patients should start ART as soon as possible after a positive HIV diagnosis, and that can be an effective way to prevent HIV from becoming AIDS and for the patient to stay healthy for many years.
Patient teaching for AIDS
Probably the most important teaching for HIV-positive patients is the need for safe sex, including using condoms, choosing lower-risk sexual activities, and pre-exposure phrophylaxis (PrEP).
If an HIV-positive patient has a sex partner who is HIV-negative, that partner can take the PrEP medication daily to essentially “ward off” the virus. This medication is very effective when taken daily.
Another important teaching for HIV-positive patients is the ongoing monitoring of their CD4+ counts. It’s important to monitor this count to ensure it does not drop too low.
It’s important for patients with HIV/AIDS to prevent infection since their immune system is compromised. Here are some tips to teach:
- They should keep really good hand hygiene by washing their hands often.
- They should bathe daily with antimicrobial soap.
- They should avoid raw and undercooked foods as well as fresh plants (potential fungus).
- They should not clean cat litter boxes (for the same reason that pregnant people should not clean cat litter boxes, because of the Toxoplasma parasite).
- They should avoid crowds and sick people.
Cathy’s teaching on HIV/AIDS is intended to help prepare you for Medical-Surgical nursing exams. The Medical-Surgical Nursing video series is intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI and NCLEX.
Hi. In this video, we are going to talk about HIV, which is human immunodeficiency virus, as well as AIDS. If you are following along with cards, I'm on Card 16.
So HIV is a retrovirus that causes decreased immunity in the patient and increased susceptibility to infections. [Pathophysiology] The virus enters the body through the blood or bodily fluids and it targets the CD4-plus lymphocytes, so those are those helper T cells that we talked about in one of the first videos in this playlist. This results in immunodeficiency, autoimmunity, and neurologic dysfunction.
In terms of the risk factors that place an individual at high risk for HIV, those factors include unprotected sex, multiple sex partners, perinatal exposure, so if a baby is born to an HIV-positive mom, then they would be at high risk for HIV, IV drug use, and then healthcare workers is also a risk factor. So that's your little reminder to do everything you can to prevent needlestick injuries and exposure to blood and bodily fluids whenever possible.
In terms of signs and symptoms of HIV, those include flu-like symptoms, lymphadenopathy, so it's enlarged lymph nodes, thrush, which is a fungal infection on the tongue, weakness, night sweats, fever, weight loss, and rashes.
In terms of the labs, when patients have HIV, their white blood cell count will be decreased. In addition, their CD4+ count will also be decreased. It will be under 500.
In terms of diagnosis of HIV, if the patient has a positive ELISA test, we would confirm that with a Western blot test.
And then if HIV goes kind of untreated, then that CD4+ count can come even lower. And if it falls below 200, that is indicative of AIDS, which is acquired immunodeficiency syndrome.
And the signs and symptoms of AIDS is much worse. So these include Kaposi's sarcoma, which is cancer of the skin and the soft tissue. The patient may have tuberculosis, pneumonia, wasting syndrome, candidiasis of the airways, so that's a fungal infection that affects the whole respiratory system, and a whole host of other infections as well.
In terms of treatment for HIV and AIDS, the patient would receive ART, A-R-T, which stands for antiretroviral therapy. So they're going to be on numerous antivirals for the rest of their lives.
In terms of patient teaching, it's going to be important to reiterate the need for safe sex. We also want to encourage PrEP, P-R-E-P, which is pre-exposure prophylaxis, for uninfected sexual partners.
We're definitely going to want to emphasize the need for ongoing monitoring of the patient's CD4+ count.
And then, we definitely want our patient to prevent infection because their immune system is compromised. So they should have really good hand hygiene. They should bathe daily with antimicrobial soap. They should avoid raw and undercooked foods as well as fresh plants. They should not clean their cat litter boxes. And they should avoid crowds and sick people as well.
Okay, so that's it for HIV and AIDS. When I come back, we will dig into cancer and the remaining videos in this playlist will be focused on cancer. So I hope this has been informative and that you're learning a lot. If so, be sure to subscribe to our channel and like the video, and I'll see you soon!
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